CPR

Written by Linda Hepler, RN | Published on July 30, 2014
Medically Reviewed by George Krucik, MD, MBA on July 30, 2014

First Aid: CPR

Cardiopulmonary resuscitation, or CPR, is a lifesaving technique. It aims to keep blood and oxygen flowing through the body when a person’s heartbeat and breathing have stopped.  It can be performed by any trained person. It involves external chest compressions and rescue breathing.

CPR performed within the first six minutes of the heart stopping can keep someone alive until medical help arrives.

Although rescue breathing techniques were used to revive drowning victims as early as the 18th century, it wasn’t until 1960 that external cardiac massage was proven to be an effective revival technique. The American Heart Association then developed a formal CPR program.

While there is no substitute for formal CPR training taught by certified instructors, the American Heart Association has recently recommended that persons who have not received CPR training initiate “hands only” CPR (without rescue breathing). This method is easy to perform, is proven to save lives, and is better than waiting until trained help arrives.

Steps for Hands-Only CPR

Survey the Scene 

Make sure it’s safe for you to reach the victim.

Check the Person for Responsiveness

Shake the shoulder and ask loudly, “Are you OK?” For an infant, tap the bottom of the foot and check for a reaction.

If the Person Is Not Responsive, Call 911

Or ask someone else to call. If you’re alone and believe the person is a victim of drowning, or if the victim is a child, begin CPR first, perform for two minutes, and then call 911.

Check the Heart with an AED

If an automated external defibrillator (AED) is readily available, use this device to check the victim’s heart rhythm and—if the machine instructs—deliver one electric shock to the victim’s heart before beginning chest compressions. If the victim is a child ages 1 to 8, perform CPR first for two minutes before checking the heart with an AED. Also, use the device’s pediatric pads if they are available. An AED’s usefulness in infants under one year of age is not conclusive or strongly recommended.  

If an AED is not immediately available, do not waste precious seconds or moments looking for the device. Start chest compressions immediately.

Locate Hand Position

For adults, place the heel of one hand in the center of the person’s chest, between the nipples. Put the other hand on top of the first hand and interlock your fingers so they are drawn up and the heel of the hand remains on the chest. For children ages one to eight, use just one hand in the center of the chest, between the nipples. For infants, place two fingers in the center of the chest, slightly below the nipple line.

Begin Compressions

For an adult, use your upper body to push straight down on the chest at least 2 inches, and at a rate of 100 compressions per minute. Allow the chest to recoil between compressions. For ages 1 to 8, push straight down on the chest about 2 inches at a rate of 100 compressions per minute, and allow the chest to recoil between compressions. For an infant, push straight down on the chest 1½ inches  at a rate of 100 compressions per minute, and again let the chest recoil between compressions.

Continue Compressions

Repeat the compression cycle until the victim starts to breathe, or medical help arrives. If the person begins to breathe, have them lie on their side quietly until medical help arrives.

Steps for Mouth-to-Mouth Resuscitation

In 2010, the American Heart Association revised its CPR guidelines, announcing that chest compressions should be performed first, before opening the victim’s airway. The new acronym C-A-B (Compressions-Airway-Breathing) now replaces the old A-B-C (Airway-Breathing-Compressions) model.   

In the first few minutes of cardiac arrest, there is still oxygen in the victim’s lungs and bloodstream. Therefore, starting chest compressions first (on an individual who is unresponsive or not breathing normally) can help send this critical oxygen to the brain and heart without any delay.

If you’re trained in CPR and come across an individual who is unresponsive or having difficulty breathing, follow the steps for Hands-Only CPR for 30 chest compressions.

Then perform the following actions:

Open the Airway

Put the palm of your hand on the person’s forehead, and tilt the head back. Gently lift the chin forward with the other hand. For small children and infants, a head tilt alone will often open the airway.

Give Rescue Breaths

This is appropriate for ages one through adulthood. With the airway open, pinch the nostrils shut, and cover the person’s mouth with a CPR face mask to make a seal. For infants, cover both mouth and nose with the mask. If a mask is not available, cover the person’s mouth with yours. Then give two rescue breaths, each lasting about one second. Watch for the chest to rise with each breath. If it does not rise, reposition the face mask and try again.

Alternate Rescue Breathing with Chest Compressions

Continue CPR, alternating 30 compressions with two rescue breaths, until the person begins to breathe or until medical help arrives. If the person begins to breathe, have him or her lie on their side quietly until medical assistance is on the scene..

CPR and AED Training

The American Red Cross and the American Heart Association (AHA), as well as other agencies, offer CPR training as well as training in the use of an automated external defibrillator (AED).

The AED is a device that can detect abnormalities in a patient’s heart rhythm and, if needed, deliver an electric shock to the chest (defibrillation) to restore normal rhythm to the heart. According to the AHA, most sudden cardiac arrests are caused by a fast and irregular heart rhythm that begins in the heart’s lower chambers, or ventricles. This is called ventricular fibrillation. An AED can help restore the heart’s normal rhythm and even help revive a person whose heart has stopped functioning.  

With training, an AED is easy to use. In conjunction with CPR, the device (when used properly) greatly increases a victim’s chances for survival.

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